Management, Referral Patterns, and Outcomes in Bell's Palsy: A Single-Institution 903 Patient Series.

Autor: Liu SW; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA.; Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA., Wright DT; Department of Head and Neck Surgery, Mid-Atlante Permanente Medical Group, Woodbridge, Virginia, USA., Abramczyk E; Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio, USA., Hadford SP; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA., Genther DJ; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA., Byrne PJ; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA., Fritz MA; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA., Ciolek PJ; Section of Facial Plastic and Microvascular Surgery, Cleveland Clinic, Head and Neck Institute, Cleveland, Ohio, USA.
Jazyk: angličtina
Zdroj: Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery [Otolaryngol Head Neck Surg] 2023 Oct; Vol. 169 (4), pp. 858-864. Date of Electronic Publication: 2023 Mar 22.
DOI: 10.1002/ohn.313
Abstrakt: Objective: In 2013, the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) published guidelines for Bell's palsy (BP), including recommendations for workup, management, and specialist referral. Patients with BP often present to primary care; however, adherence to guidelines may vary by setting. This study sought to evaluate the management of patients with BP presenting to primary care, emergency department (ED), and urgent care settings.
Study Design: Retrospective cohort study.
Setting: Tertiary care center.
Methods: Retrospective chart review of patients identified by diagnosis code for BP.
Results: A total of 903 patients were included; 687 (76.1%) presented to ED, 87 (9.6%) to internal medicine, 77 (8.5%) to family medicine, and 52 (5.8%) to urgent care. On presentation, 804 (89.0%) patients were prescribed corticosteroids and 592 (65.6%) antiviral therapy. Steroid therapy ranged from 1 dose to greater than a 14-day course, with 177 (19.6%) receiving an adequate duration of 10 days or greater. Referrals were provided to facial plastics and/or otolaryngology for 51 patients (5.6%). For all comers, 283 (31.3%) had complete resolution, 197 (21.8%) had an incomplete resolution, 62 (6.9%) had persistent palsy, and 361 (40.0%) lost to follow-up. In assessing the association between clinic setting and management, appropriate corticosteroid therapy (p < .01), imaging (p < .01), and eye care (p < .01) were statistically significant.
Conclusion: Adherence to guidelines for BP management varies amongst providers. In our study cohort, 15.5% of patients received medical therapy in accordance with AAO-HNS guidelines, and only 5.6% were referred to facial plastics. To facilitate more appropriate care, tertiary care institutions may benefit from system-wide care pathways to manage acute BP.
(© 2023 The Authors. Otolaryngology-Head and Neck Surgery published by Wiley Periodicals LLC on behalf of American Academy of Otolaryngology-Head and Neck Surgery Foundation.)
Databáze: MEDLINE
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